Title

Abstract

Introduction: Syncope remains one of the most challenging presentations to the ED physician as well as the Internist. The goal of this study is to determine which combination of variables during the clinical encounter at bed side can better predict among all patients presenting to the ED with syncope who is likely to have a cardiac diagnosis and who is not.

Methods: A retrospective chart review was done on a random sample of cases presenting to the emergency department of a Miami hospital between 2014 and 2016.

Results: The final regression model showed male patients being 3 times more likely to have a cardiac final diagnosis for syncope than women. There is a 5% increased chance of having a cardiac etiology per year increment between these groups. Palpitations occurring with the event and a personal history of coronary artery disease multiplied the odds of a cardiac diagnosis 24.43 times and 3.63 times respectively. Bradycardia or a prolonged QRS segment (>120ms) multiplied the odds of a cardiac diagnosis by 4.24 times and 5.06 times respectively. Valvular stenosis on cardiac echography multiplied the odds of having a cardiac diagnosis by a factor of 7.35. ROC curve was calculated to be 0.901. Creating a model excluding the result of the cardiac echography yielded a ROC curve with an area under the curve of 0.895.

Conclusion: Syncope has a variety of etiologies some of which are benign in nature like Orthostasis, others carry a high risk of severe detrimental consequences like cardiac arrhythmias. Thus, it is imperative to differentiate those patients with a potential of having a life-threatening diagnosis from those that do not. The cardiac model developed during this study showed great potential for development of a stratification risk tool for cardiac diagnosis for patients presenting with a syncopal episode to the ED.